Tsarin Lupus Erythematosus (SLE)-02

Majinyaciyar mace ce 'yar shekara 20 da ke fama da cutar lupus erythematosus mai tsanani da sauri. Duk da maganin da aka yi mata da hydroxychloroquine sulfate, azathioprine, mycophenolate mofetil, da belimumab, aikin kodanta ya lalace cikin watanni biyar, wanda ya haifar da mummunan nephritis tare da proteinuria (ƙimar creatinine ta awanni 24 ta kai 10,717 mg/g) da kuma ƙananan hematuria. A cikin makonni huɗu masu zuwa, matakin creatinine ɗinta ya karu zuwa 1.69 mg/dl (tsakanin al'ada 0.41 ~ 0.81 mg/dl), tare da hyperphosphatemia da renal tubular acidosis. Binciken biopsy na koda ya nuna matakin 4 na lupus nephritis. Ma'aunin aikin NIH da aka gyara shine 15 (matsakaicin 24), kuma ma'aunin chronicity na NIH da aka gyara shine 1 (matsakaicin 12). Majinyaciyar ta sami raguwar matakan kari da kuma ƙwayoyin rigakafi da yawa a jikinta, kamar ƙwayoyin rigakafi na antinuclear, DNA mai hana ƙwayoyin cuta biyu, anti-nucleosome, da anti-histone.

Bayan watanni tara, matakin creatinine na majinyacin ya tashi zuwa 4.86 mg/dl, wanda hakan ya buƙaci dialysis da maganin rage hawan jini. Sakamakon gwaje-gwajen dakin gwaje-gwaje ya nuna maki 23 na SLE Disease Activity Index (SLEDAI), wanda ke nuna wata mummunar cuta. Sakamakon haka, majinyacin ya yi maganin CAR-T. Tsarin maganin ya kasance kamar haka:

- Mako guda bayan shigar da ƙwayoyin CAR-T, tazara tsakanin zaman dialysis ya ƙaru.

- Watanni uku bayan allurar, matakin creatinine ya ragu zuwa 1.2 mg/dl, kuma ƙimar tacewa ta glomerular (eGFR) ta ƙaru daga mafi ƙarancin 8 ml/min/1.73m² zuwa 24 ml/min/1.73m², wanda ke nuna cutar koda ta mataki na 3b mai tsanani. An kuma rage magungunan hana hawan jini.

- Bayan watanni bakwai, alamun cutar amosanin gabbai sun ragu, abubuwan da suka haɗa da C3 da C4 sun koma daidai cikin makonni shida, kuma ƙwayoyin rigakafi na antinuclear, anti-dsDNA, da sauran ƙwayoyin rigakafi na autoantibodies sun ɓace. Aikin koda na majiyyaci ya inganta sosai, inda proteinuria na awanni 24 ya ragu zuwa 3400 MG, kodayake ya ci gaba da ƙaruwa a binciken ƙarshe, yana nuna wasu lalacewar glomerular da ba za a iya gyarawa ba. Yawan albumin a cikin jini ya kasance daidai, ba tare da kumburi ba; nazarin fitsari bai nuna alamun nephritis ba, kuma babu hematuria ko ƙwayoyin jini ja. Majiyyacin yanzu ya koma rayuwa ta al'ada.